This proposal is submitted in response to RFA: HD-O0-012 entitled "Epidemiologic Research on Female Pelvic Floor Disorders." Urinary incontinence (UT) and pelvic organ prolapse (POP) are common health problems in older women, for which the etiologies are poorly understood. Injuries to the pelvic floor at the time of vaginal delivery and genetic predisposition have been implicated as factors associated with UT and POP. However, the epidemiological evidence for these relationships is scant and controversial. Our data from a survey study of 149 nulliparous nuns found the same prevalence of stress urinary incontinence (S UT) as was reported for parous women. The major objective of our proposed study is to determine whether vaginal delivery and familiality are associated with the development of urinary incontinence and pelvic organ prolapse by comparing the prevalence of objectively confirmed incontinence and prolapse in nuns (nulliparous women) with the corresponding rates in their biological sisters who have had at least one vaginal delivery. To achieve this objective, we will: recruit the nuns' biological sisters who have had at least one vaginal delivery; collect data from nuns and their sisters about the presence of any symptoms of UT and POP, and on any risk factors for these conditions; and examined nuns and sisters for objective evidence of UT and POP. The examiner will be blinded to the subjects' identity as to nun or sister, and to the presence or absence of symptoms. Women with signs or symptoms of UT and POP will undergo further urodynamic testing. Finally, the data collected will be tested in a matched pair analysis. We will determine whether nulliparous nuns differ from their biological sisters with regard to UT and POP. A matched pair logistic regression will be performed to obtain an adjusted estimate of the impact of familiality and vaginal delivery in UT and POP, taking into account other risk factors.